Wednesday, March 30, 2016

Cutting-edge Technology for the Visually Impaired Comes to Central PA



This Post was Written by North Central Sight Services, Inc.

With the help of technology, North Central Sight Services, Inc. is expanding capabilities of the visually impaired in our region. In January, North Central Sight Services, Inc. launched a campaign to raise funds for eSight eyewear. These enhanced eyeglasses use an ultra-high definition video stream through a camera to improve image quality and clarity for individuals who are visually impaired.  eSight eyewear works by converting images that an individual sees into images that can be manipulated in size, contrast, and color – all in real time. It has helped people with Macular Degeneration, Diabetic Retinopathy, Stargardt’s Disease, and other conditions.

North Central Sight Services is the second agency in the country to utilize eSight to increase job opportunities for individuals who are visually impaired. The agency identified twelve individuals in its industry employment program that could benefit from eSight. One unit costs approximately $15,000. With the help of donations and support from events such as Raise the Region and Dining in the Dark, North Central Sight Services, Inc. was able to purchase two eSight eyeglass units. The goal for 2016 is five units.

Support North Central Sight Services, Inc. and give the gift of eSight.  To learn more about eSight and to make a secure contribution online, visit www.ncsight.org. 

Monday, March 14, 2016

Honor Thy Mother and Father

[The following article was written by my long time co-worker and friend, Karen Griswold. She describes her recent experience helping move Mom and Dad  to a Senior Independent Community. It shows how things can go right when families work together to support their aging parents. Thanks so much to Karen for sharing this personal story].

Honor Thy Mother and Father
My flight landed in Raleigh, NC on Saturday, February 6, 2016.  I had planned a week’s vacation to spend time with my parents.  On the agenda, was an appointment with an elder law attorney to get their estate planning documents in order.  Dad is 84 and has multiple chronic illnesses.  Mom is 74 and in relatively good health.  Mom had slowly become dad’s primary caregiver.  During the past year, my parents had started to give cues that continuing to live in their two-story home was becoming too much for mom to manage.  We just had to listen.    
A few weeks prior to my arrival, discussions had started on the different living options.  My parents thought it would be a good idea to have a family meeting, to discuss their options.  This turned out to be very valuable in our pre-planning processes; everyone contributed different ideas and suggestions and we compiled our personalized checklist for touring different senior communities.  I thought it was important for mom to see and understand the different levels of care provided at the different communities.  Our first stop was at a personal care community.  After talking with the staff and viewing the community, it was clear that this was too restrictive of an environment for them; they did not require this level of care. 
We were then able to focus our time on touring five different independent senior communities.  Without the checklist we never would have remembered all of the details of each community.  My dad was able to tour two of the communities, and he fell in love with the very first one, which turned out to be the one they selected.  We shared our findings with the rest of the family and by Thursday we had our second family discussion about moving forward.  
The community they selected included moving services where they “packed, moved, and unpacked” new residents.  My brother and his wife took charge of the items that remained in the home, after the move.  My sister and her husband were the most experienced in handling real estate, so they took charge of selling or leasing my parents’ home. 
By the end of February, my parents were in their new home; an apartment in an all-inclusive, resort-style community, developed exclusively for adults 55 and over.  Their new home has two bedrooms, two bathrooms with walk-in showers, a full kitchen, washer and dryer, all utilities, including high-speed internet, 24/7 professional staff, medical alert system, concierge services, free scheduled transportation, freedom dining, room service, valet parking, weekly housekeeping, maintenance staff, secure access for safety, health & wellness programs, daily social invitations & activities, shopping & outings, fitness center,  a stadium seating theatre, library, computer center, and on-site banking services, pharmacy/gift shop, salon/barber, and caregiver agency.  It reminded me of a cruise ship.
My parents chose to be proactive instead of reactive.  We have been blessed with a close and loving family.  Although we all have our own opinions, our parents continue to make their own decisions and are in control of how they live their lives.  We are all there to support them.  I was able to personally experience how very different the government elder services and community resources vary between the states and counties.    
Each Friday night, the community has a happy hour.  My sister and her husband enjoy this event with our parents.  One of her recent texts said, “Dad is a different person.  He is singing, dancing, laughing and talking to everyone.”

Friday, March 11, 2016

Finding the Right Nursing Home



Millions of Americans need help meeting their care needs. This may include assistance with fundamental tasks like bathing, dressing, using the toilet, incontinence, transferring to or from a bed or chair, and eating. These tasks are commonly referred to as “activities of daily living.”
Many people who need help with activities of daily living can continue to live at home. Unpaid care-giving by family and friends is the main source of this assistance.  Today, a large percentage of our nation’s long term care needs are met in the home by care provided by family members and friends. 
But care requirements can rise to a level than cannot be appropriately met at home. Because of family circumstances or the level of care required or the cost of round the clock care, home care can place unacceptable burdens on the family and put the care recipient at risk. If the care recipient does not need a high level of medically oriented support there are a number of residential care alternatives that may become appropriate. For a discussion of these options see my previous blog post When Mom Can't Live Safely at Home - Residential Care Facility Options for Seniors.
If care requirements are complex or extensive or require skilled medical support a traditional nursing home may the best residential care option. [When I use the term “nursing home” in this article I mean a facility that provides 24-hour health care services including basic and skilled nursing care, rehabilitation, and a full range of other programs, treatments and therapies such as occupational therapy and physical therapy.] Nursing homes may also manage complex medical needs that require equipment, such as ventilators and IV lines. Nursing homes are medical facilities that are inspected and licensed in Pennsylvania by the state Department of Health. They must comply with both state and federal regulations.
Nursing homes are sometimes referred to as “skilled nursing facilities” or “long term care facilities” or “nursing care facilities” but are most commonly simply called nursing homes. I will use that term.
Nursing homes may be stand-alone or they may be part of a hospital or of a Continuing Care Retirement Community. As of June 30, 2012, there were 713 nursing homes in Pennsylvania with a total bed capacity of over 88,000. Most, but not all, facilities accept Medicare and Medicaid for those who qualify for benefits under those programs. Other sources of payment include private payment, long term care insurance, and VA benefits. Since some nursing homes do not accept Medicaid – you should check in advance if there is a possibility that the resident may someday run out of private payment funds and need to rely on Medicaid.
Pennsylvania residents can check the Pennsylvania Department of Health’s Nursing Care Facility Locator Page to find nursing homes near them. And Medicare provides a list of Medicare participating nursing homes on its Nursing Home Compare website. The Medicare site is deep with information and gives each home a quality rating between 1 and 5 stars. There is one overall rating for each nursing home, and a separate rating for each of the following three sources of information:
  • Health Inspections – based on information from the last 3 years of onsite inspections;
  • Staffing – based on the number of hours of care provided on average to each resident each day by nursing staff; and  
  • Quality Measures – based on 11 different physical and clinical measures for nursing home residents.  
Of course, as Medicare itself cautions, “no rating system can address all of the important consideration that go into a decision about which nursing home may be best for a particular person.  Examples include the extent to which specialty care is provided (such as specialized rehabilitation or dementia care) or how easy it will be for family members to visit the nursing home resident.” Family visits can improve both the residents' quality of life and quality of care, so it may actually be better to select a nursing home that is very close over one that is higher rated but far away. 
Consumers should therefore not rely solely on the Nursing Home Compare website. Consider other sources of information including that provided by state and local organizations (such as local advocacy groups and the State Ombudsman program). 

Consumers should therefore not rely solely on the Nursing Home Compare website. Consider other sources of information including that provided by state and local organizations (such as local advocacy groups and the State Ombudsman program). 

The quality of the care provided by a nursing home is dependent on its staff. And there is often a lot of staff turnover. This means that the quality of the care in a particular facility can vary greatly over time. And some floors or units in a facility can have staff that provide better care than another unit in the same facility. The knowledge and opinions of current or recent residents of a facility and their family members can be an invaluable source of guidance.

If you are fortunate enough to know residents of the facility or members of their families don’t hesitate to talk with them. And, if you can, consult with a local professional care manager who is independent of the facilities you are considering. 

Be sure to include personal visits to the nursing homes you are considering. But beware of referral companies that are paid by facilities to make referrals to them. You need independent recommendations from local people who have no financial conflict of interest.
The law firm Marshall, Parker and Weber has written a Nursing Home Guide that provides in-depth information about how to choose the right nursing home and get the best care there. (The Nursing Home Guide is free but registration is required.) The Guide can be accessed on the law firm’s website at http://www.paelderlaw.com/consumer-booklets/. 

Sunday, March 6, 2016

Are Children Required to Support their Aging Parents?

Most Americans underestimate the risk that they will someday develop a disability and will require assistance and support on a daily basis. But research shows that more than half of Americans turning 65 today will develop a disability serious enough to require long term care. It’s the reality of aging.

Much of the care needs of older adults are met by family members at no financial cost to the recipient. But when care must be purchased, it can be very expensive. A recent government report estimates that on average, an American turning 65 today will incur $138,000 in future long term care costs.

The cost of care is often more than an older adult can afford to pay. If a parent cannot meet their care and maintenance needs are their children obligated to provide and/or pay for that care?  In Pennsylvania, the answer is yes. A child can be sued and held financially responsible to help a parent with the cost of their care and maintenance. (In like manner, parents can be held liable to help pay for care needed by their adult children.)

This family support obligation between parents and children is often referred to as “filial support.” 

The Pennsylvania’s Domestic Relations Code contains the law that requires children to provide support for their “indigent” parents. Here is what this Pennsylvania statute says:

(a)  Liability.--
(1)  Except as set forth in paragraph (2), all of the following individuals have the responsibility to care for and maintain or financially assist an indigent person, regardless of whether the indigent person is a public charge:
(i)  The spouse of the indigent person.
(ii)  A child of the indigent person.
(iii)  A parent of the indigent person.
(2)  Paragraph (1) does not apply in any of the following cases:
(i)  If an individual does not have sufficient financial ability to support the indigent person.
(ii)  A child shall not be liable for the support of a parent who abandoned the child and persisted in the abandonment for a period of ten years during the child's minority.

The statute does not define the term “indigent person” but courts have held that a person is indigent if they have insufficient means to provide themselves with the care and support they need. One Pennsylvania court described indigency under this law as follows:

“Indigent persons are those who do not have sufficient means to pay for their own care and maintenance. ‘Indigent’ includes, but is not limited to, those who are completely destitute and helpless. It also encompasses those persons who have some limited means, but whose means are not sufficient to adequately provide for their maintenance and support.” HCR v. Pittas, 2012 Pa Super 96 (Pennsylvania Superior Court, May 7, 2012).

It is fairly clear that a person who needs care (whether in their own home or in a nursing or personal care home) and who runs out of the means to pay for that care fits this definition of indigent person.

Care Providers Can Sue the Children

The law authorizes an indigent parent to sue an adult child for filial support. The law also authorizes nursing homes and other care facilities to sue the children of their residents for unpaid services. 23 Pa.C.S.A. §§ 4603(c)(1)(2).

If payment for services rendered has not been made, a care facility obviously has a strong financial incentive to pursue the children for support. In Pennsylvania many such lawsuits are filed. In the HCR v. Pittas case mentioned above, a son was held liable for his mother’s $93,000 nursing home bill even though there was no allegation that the son had ever received gifts from the mother.

Another recent case is EORI v. EORI which was decided by the Pennsylvania Superior Court on August 7, 2015. Mrs. Eori, a 90 year old widow with three children, was living full-time with her son Joseph. She was suffering from Alzheimer’s and required extensive assistance. Acting as his mother’s power of attorney, Joseph filed a lawsuit against his sister Pauline and his brother Joshua, seeking filial support for their mother.

Pauline settled before trial and agreed to pay $400 a month in support to her mother. Joshua refused to settle and after a trial the lower court ordered him to also pay his mother $400 a month.

Joshua appealed from the court order. Among other things he argued that his mother was not indigent because his brother Joseph was supporting her. Joshua also argued that he was incapable of financially supporting his mother; and that he should not be required to pay support because his mother had abandoned him for ten years during his minority.

The court rejected all of Joshua’s arguments and affirmed the order that he contribute $400 a month for the support of his mother.

My guess is that in other similar cases, where one child is bearing the majority of the physical, financial, and emotional burdens of caring for a parent, courts are likely to be sympathetic to requests for financial contribution from other children. The filial responsibility law provides an effective vehicle for the care provider child to seek that contribution.

Children need to be aware of their responsibility to support their aging parents. They disregard this obligation at their peril. Children should encourage their aging parents to plan in advance so that the parent will be able to qualify for Medicaid, Veterans, and other benefits if needed and will always have the means to pay for the care they need.

A lack of planning by the parent, or poor planning, combined with later health problems, can trickle down and end in significant financial liability for the child. It can even extend to siblings suing each other as shown by the Eori case. If the need for long term care is in the picture, effective planning combined with expert advice regarding the ever shifting Medicaid and support laws, can help protect not only the parent's assets, but the children’s finances as well.

Note: some people wrongly assume that a child can only be held liable if their parent gave them money or property. But the Pennsylvania law is much broader than that. Whatever the reason your parent became indigent, you have the obligation to support them if you have the means to do so, even if no gifts were ever made. While this liability can arise in situations where a parent is ineligible for Medicaid because they gave assets away, it can also arise where Medicaid and transfers are not involved. The child’s financial support obligation is based on Pennsylvania’s family support laws, not Medicaid laws.

Is your parent in danger of needing care that may someday exhaust their savings? If so, and your parent resides in Pennsylvania or another state with a similar filial support law, you need to get expert help to make sure you don’t end up being personally liable for the cost of their care. Make an appointment with an experienced elder law attorney to find out about your family's planning options. In Pennsylvania, you can call Marshall, Parker and Weber, which has offices in Williamsport, Wilkes-Barre, Scranton and Jersey Shore.  Check us out at www.paelderlaw.com.

Free Webinar on Filial Support

If you want to know more about Pennsylvania’s filial support laws, you can register for a free webinar being given on March 16, 2016 by attorney Nicholas Lutz of Marshall, Parker and Weber. Register here: http://www.paelderlaw.com/seminars-signup/.

If you miss the live webinar you can listen to it later on the Marshall, Parker and Weber website here: http://tinyurl.com/hxzmgv5.

Friday, March 4, 2016

Community Options: an Alternative Living Arrangement for Disabled Adults



[The following article was written by Nicholas Lutz, an attorney with my law firm, Marshall, Parker and Weber.]
Recently, I had the opportunity to meet with Peter Fisher, executive director of the Pocono Regional Office of Community Options, an alternative living arrangement for disabled adults. Touring the office, seeing the resident’s homes and engaging with the staff was quite an experience for me.
Community Options provides an alternative to more traditional group home living for disabled adult individuals. The organization finds and acquires appropriate housing for two or three (max) individuals. Typically, the homes are three bedroom ranch-style buildings which are then customized to the needs of the residents.
You can learn a lot about someone by visiting their home. I had the good fortune to visit a number of the homes Community Options is using for their program. If I had to sum up my experience in one word, I would use empowerment. Community Options is an organization where the employees practice what is preached and the end result is that the residents are empowered to engage in the world around them and make decisions.
When you step into one of the Community Options homes, you’ll see an array of items that interest the residents there – video game systems, stereo equipment, model vehicles, spiffy hats, posters, etc. You may find pictures of family members and mementos from outings the resident has been on. You will see that the living space is truly tailored to the needs and wishes of the residents. Choice of entertainment and even d├ęcor are left to them to decide. The residents may, for example, choose what color to paint their room and even paint the space themselves if they are so inclined.
You can also learn a lot from what you don’t see. You won’t see company logos or markings. The home doesn’t have any sign that would announce to a passerby that it belongs to Community Options. The car the company provides for transportation is just a normal, unmarked car lacking any company logos or pictures. This is by design - these are measures the company takes to provide a sense of normalcy for the residents.
Peter explains that he has two goals for each of his residents – ‘normalization and dignity of risk.’ His desire is that residents lead as normal and independent a life as possible and engage in activities they want to participate in even where there may be some risk involved because the individual has a disability. From touring the Community Options homes, it’s apparent that the organization takes the goal of normalization seriously.
Assisting residents to accomplish their goals is also important. Frequently, Peter says – ‘if a resident wants to go horseback riding we’ll find a way to help them go horseback riding.’ There’s an element of danger to any of us engaging in horseback riding. With proper accommodations, an individual with a disability should be able to assume that risk just as someone without a similar disability may.
Although Peter often uses horseback riding as an example of what he means by ‘dignity of risk,’ my sense is that it’s a true interest the organization has helped a former or current resident pursue. Just as with the goal of normalization, the organization practices what Peter preaches in helping residents pursue their interests even where there may be some risk involved.
The program is flexible so that residents who aspire to be employed can work towards that goal and other residents participate in day programs so that they are out of the house and engaged in the community. As a testament to the fact that residents are strongly encouraged to engage in the community, I can share that while I was touring the homes, all residents were out and about, participating in their day programs.
Another major perk Community Options residents enjoy is individual attention. Each resident works closely with a number of staff members throughout the day and because the maximum number of residents per home is three they each receive a great deal of personal attention.
One of the greatest pleasures of my morning was speaking with a house manager. He was able to tell me all about his resident. He told me about his likes and dislikes, past outings they had been on and future outings they had planned. He gushed about the progress his resident has made since being enrolled in the program and spoke about ways they are helping empower his resident to work towards independence.  The enthusiasm he showed when speaking about his resident’s progress and the passion he displayed about the Community Options program was palpable. It was impressive to see and hear and really capped off a terrific morning for me.
To learn more about Community Options, you can visit their website by clicking here. If you’re the social media type, you can also follow #comopcares on Twitter.